Epidemiology
High Lp(a) patients with intracranial stenosis get the most benefit from remote ischemic conditioning, RICA trial analysis of 1,286 patients finds (Neurotherapeutics 2025)
Original title: Lipoprotein(a), remote ischemic conditioning, and stroke recurrence in patients with symptomatic intracranial atherosclerotic stenosis
This analysis of the RICA trial, a randomised study of chronic remote ischaemic conditioning in patients with symptomatic intracranial atherosclerotic stenosis (ICAS) across 84 Chinese stroke centres, examined the relationship between Lp(a) and recurrent ischaemic stroke in 1,286 patients aged 40-80. Those with Lp(a) above 17.4 mg/dL had markedly higher stroke recurrence (adjusted HR 1.38, 95% CI 1.05-1.80, P = 0.02), and each doubling of Lp(a) raised recurrence risk by 18% (adjusted HR 1.18, 95% CI 1.09-1.29, P < 0.001). Among participants with high Lp(a), those randomised to remote ischaemic conditioning had lower stroke incidence than controls (16.7% vs. 22.6%, adjusted HR 0.67, 95% CI 0.47-0.96, P = 0.03). The authors conclude elevated Lp(a) independently predicts stroke recurrence in symptomatic ICAS, and that patients with higher Lp(a) may derive greater benefit from remote ischaemic conditioning, a low-cost, non-pharmacological intervention, though further validation is needed.
Original abstract
This study is to determine symptomatic intracranial atherosclerotic stenosis (ICAS), a significant stroke cause with high recurrence risks, by examining the relationship between lipoprotein(a) and ischemic stroke recurrence. Analyzing data from the RICA trial (chronic remote ischemic conditioning in patients with symptomatic ICAS) involving 1286 patients aged 40-80 years across 84 Chinese stroke centers, we found that participants with lipoprotein(a) levels above 17.4 mg/dL experienced markedly higher stroke recurrence rates (adjusted hazard ratio [HR], 1.38; 95 % CI, 1.05-1.80; P = 0.02), with each doubling of lipoprotein(a) increasing recurrent stroke risk by 18 % (adjusted HR, 1.18; 95 % CI, 1.09-1.29; P < 0.001). Notably, among high lipoprotein(a) participants, the remote ischemic conditioning group demonstrated a lower stroke incidence (16.7 %) compared to the control group (22.6 %), suggesting potential therapeutic benefits (adjusted HR, 0.67; 95 % CI, 0.47-0.96; P = 0.03). The study revealed that elevated lipoprotein(a) levels are independently correlated with increased recurrent ischemic stroke risk in patients with symptomatic ICAS, and those with higher lipoprotein(a) levels might derive more clinical advantages from remote ischemic conditioning. Additional research is required to validate these results.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.